Various agents have been tried with an aim to prevent post ERCP pancreatitis in the last 10 years. These include Gabexate, Somatostatin, Nifedipine, Octreotide, Hydrocortisone, Prednisone, Allopurinol, Interleukin-10, and Methylprednisolone which have been evaluated in randomized controlled studies.Of these agents only Interleukin-10, Somatostatin and Gabexate have been found efficacious. However 13 patients need to be treated prophylactically with Somatostatin and 27 with Gabexate to prevent a single case of post ERCP pancreatitis. Hence these agents are unlikely to be cost-effective or universally applicable. The ideal agent to prevent this complication should be cheap, widely applicable and have a rational basis.